Provider Demographics
NPI:1477581239
Name:KOHANIM, MOOSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOOSA
Middle Name:
Last Name:KOHANIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14516 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1519
Mailing Address - Country:US
Mailing Address - Phone:310-219-0890
Mailing Address - Fax:310-219-0297
Practice Address - Street 1:14516 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1519
Practice Address - Country:US
Practice Address - Phone:310-219-0890
Practice Address - Fax:310-219-0297
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35085174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist